Functional Neurological Disorder is Associated with Postoperative Complications After ACDF: A Retrospective Propensity-Matched Analysis - 06/08/26

Doi : 10.1016/j.neuchi.2026.101866

Samuel A. Florentino ^a,⁎ , Christopher J. Kaszluga ^b, Vu Bui ^b, Ankit Hirpara ^a, Jalen Warren ^a, Nakul Narendran ^a, Alexander N. Berk ^a, Logan M. Good ^a, Jonathan Belding ^c

^a Case Western/University Hospitals, Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH 44106

^b Albany Medical College, 43 New Scotland Ave, Albany, NY 12208

^c MetroHealth Medical Center, 2500 Metrohealth Dr, Cleveland, OH 44109

^⁎ Corresponding author.

Sous presse. Manuscrit accepté. Disponible en ligne depuis le Thursday 06 August 2026
Cet article a été publié dans un numéro de la revue, cliquez ici pour y accéder

Highlights

•	Functional neurologic disorder (FND) was associated with increased complication risks after anterior cervical discectomy and fusion (ACDF).
•	FND was associated with significantly increased risk of surgical site infection and rehospitalization after ACDF.
•	FND was associated with significantly increased risk of pseudoarthrosis and opioid use disorder at two years after ACDF.

Le texte complet de cet article est disponible en PDF.

Abstract

Introduction

Psychiatric comorbidities are associated with worse postoperative outcomes after cervical spine surgery, yet the impact of Functional Neurological Disorder (FND), a neuropsychiatric condition characterized by involuntary neurologic symptoms, has not been investigated. The objective of this study was to evaluate the association between FND and perioperative and long-term complications following anterior cervical discectomy and fusion (ACDF).

Methods

The TriNetX United States Collaborative Network was used to examine adults (≥18 years) undergoing primary ACDF between 2004 and 2023. Patients were stratified into cohorts based on the presence or absence of FND prior to surgery. Patient demographics and comorbidities were 1:1 propensity score matched. The primary outcomes were complications within 90-days and 2 years after ACDF.

Results

89,338 patients underwent ACDF, and 502 (0.56%) had FND. After 1:1 matching, 501 FND and 501 control patients were analyzed. Within 90 days, FND was associated with higher odds of dysphagia (OR 2.05, 95% CI 1.37-3.07, p < 0.001), surgical site infection (SSI) (OR 2.84, 95% CI 1.34-5.86, p = 0.004), ED utilization (OR 1.92, 95% CI 1.38–2.67, p < 0.001), and hospitalization (OR 1.82, 95% CI 1.21-2.28, p = 0.001). At 2 years, FND patients had greater odds of pseudoarthrosis (OR 1.49, 95% CI 1.05–2.11, p = 0.026) and opioid use disorder (OR 2.36, 95% CI 1.11-5.01, p = 0.021).

Conclusion

FND was associated with increased perioperative and long-term complications following ACDF, including dysphagia, SSI, pseudoarthrosis, and opioid use disorder. Preoperative identification of FND may enable targeted perioperative management and multidisciplinary follow-up to mitigate risk in this complex population.